Lots of planning behind 'miracle' recovery

By CATHLEEN F. CROWLEY Staff writer

Published 12:21 am, Saturday, November 27, 2010

Left to right: Cardiologist Dr. Guillermo Sosa-Suarez, on staff at St. Peter's Hospital, with his miracle patient Robert Schmit, who, weeks ago, suffered a cardiac arrest while working out at a health club with his girlfriend and subsequently slipped into a coma. Without the "Perfect Storm" of quick acting medical professional, including the CPR intervention of Schmit's girlfriend, Julia Palma, who happens to be an RN, the St. Peter's Hospital Cardiac Cath Lab, the use of a therapeutic hypothermia blanket, and the innovative work of Dr. Guillermo Sosa-Suarez, it is believed that Schmit would have died. While in the coma it was for a time thought that the 27 year old was brain dead. Now discharged from the hospital, the happy ending is that he seems to have no mental impairment, and a new lease on life. ?The dr. and patient and other hospital staff had a reunion in the Cardiac Wing of St. Peter's in Albany, NY, on Monday, Nov. 15, 2010, when Schmit and his family came for a visit after some followup medical appointments. Photos for upcoming medical story by Cathleen Crowley, and for a Web Gallery. (Luanne M. Ferris / Times Union )

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COLONIE -- Bob Schmit stepped off the elliptical machine and told his girlfriend he was going to the bathroom. Then he dropped to his knees.

Schmit, a muscular 27-year-old, was in cardiac arrest.

In the middle of Planet Fitness in Loudonville, his girlfriend Julia Palma -- a nurse -- started CPR with help from an off-duty firefighter. A gym employee ran over with a portable defibrillator and hooked the machine up to Schmit. The device shocked his heart back into rhythm.

Colonie emergency responders put a breathing tube into Schmit's lungs, packed ice around his body, injected chilled saline into his blood and raced him to the hospital.

Schmit's doctors said it was a miracle that he survived. But in reality, Schmit's recovery was part of an orchestrated effort by Colonie EMS and local hospitals to bring people back from the dead.

The American Heart Association reports that an estimated 95 percent of cardiac arrest victims die before they get to the hospital. That was true in Colonie five years ago, but not any more.

In 2005, Colonie began revamping the way its emergency responders treat the town's approximately 65 annual victims of cardiac arrest. Each year, they introduced new protocols following Heart Association-recommended guidelines. Results have been exceptional, said Dr. Michael Dailey, regional EMS medical director and a emergency medicine physician at Albany Medical Center. Dailey presented Colonie's experience at an AHA conference earlier this month.

The town's EMTs started using "mechanical CPR" sooner.

They began using a devices known as a "thumper" that can be placed on the victim's chest and delivers nearly perfect CPR in the field. Colonie continued to improve their CPR methods and focused on opening patients' airways.

In each of those first two years, three people survived cardiac arrest, about a 5 percent survival rate -- pretty typical compared to national rates.

In 2007, Colonie's 911 dispatchers suggested giving EMS crews the victim's address immediately rather than waiting until they collected all the information from a 911 caller. Dailey estimated it shaved a minute off the response time.

"A minute doesn't sound like a lot unless your brain is not getting oxygen -- in which case a minute is a long, long time," he said.

EMS crews also started to routinely use an "impedance threshold device," which increases blood flow to the heart and brain during CPR by controlling the pressure inside the chest cavity.

Throughout their initiative, Colonie EMS has campaigned and educated the community to improve bystander CPR rates and encourage businesses to invest in portable defibrillators.

Six people lived through cardiac arrest in 2007, a 10 percent survival rate.

"That's six people who got their family members back, and that's twice what it was the year before," Dailey said. "That's pretty dramatic."

It only got better.

The following year, Colonie EMS fine-tuned its CPR techniques. Arriving at a scene of a cardiac arrest, first responders gave two minutes of CPR before shocking the heart.

This approach quite literally primed the pump by pushing oxygenated blood into the heart; when crews delivered the bolt of electricity, the heart had a fresh load of blood to deliver to the brain and body.

Seven people lived that year, increasing the survival rate to 12 percent.

In 2009, Colonie EMS made a landmark decision: Its ambulances would only bring resuscitated patients to hospitals that offered therapeutic hypothermia.

At the time, Albany Medical Center was the only local hospital that offered the therapy. But St. Peter's Hospital and Ellis Hospitals jumped on board quickly.

"It was one of those times that competition was a good thing," Dailey said.

Patients who survive cardiac arrest often die or suffer severe brain damage when blood flow is restored to the body.

The prevailing theory is that the oxygen-rich blood sets off a series of traumatic reactions in the brain that kill off cells, said neurologist Gary L. Bernardini, a director of stroke and neurocritical care at Albany Med.

Chilling the body decreases the damage, he said.

Colonie's first patient to be chilled was high school physics teacher Bernie Phillips. The Latham resident went into arrest while sleeping on Jan. 3, 2009. His wife called 911 and began CPR. After a press conference and rehabilitation, the 48-year-old was back in the classroom teaching in a matter of weeks.

He has become the poster boy for the cooling therapy in the Capital Region.